Hi, I've been on Nal for about 6 weeks now, and have come up with some theories. These are based on my own experience, and from reading the experiences of others on this board, and are intended more for discussion than as any kind of fact based argument.

1) The Honeymoon Period is a Side Effect: The initial side effects of this drug appear to be far more powerful than Dr. Eskapa suggests. Alongside the nausea, spaciness, and fatigue, I really did experience a reduced craving to drink. Although I tend to desire alcohol less when I am nauseous, I don't believe the nausea itself could factor for my reduced craving. Perhaps a chemical mechanism in its own right, the reduced craving to drink seemed to last, for me, only a couple of weeks. This period happened to coincide almost exactly with my fatigue. Not sure if they are indeed related, but there is no doubt in my mind that the chemical changes Nal introduced was responsible for both.

2) The Honeymoon Period can Kickstart Temporary Abstinence: Interestingly enough, I was prescribed Nal by my doctor because he learned somewhere that the drug has potential to reduce craving. I've since read many many case studies where, combined with the willpower to abstain, Nal has successfully help individuals enter in to periods of abstinence in their lives. My own theory on this is that the Nal honeymoon period, combined with willpower, allows individuals to learn that, over a multiday period, they can live without alcohol. Many of us who have attempted to white knuckle know that the first day is the hardest, followed by the second, followed by the third, until you really actually don't feel like drinking until a major trigger rears its ugly head. The initial honeymoon side effect of Nal I believe can help people get to that point. That being said, such a technique, I believe, is not as effective a long term strategy as TSM itself, but merely an interesting observation. I wonder so much about this because it that observation is the reason my doctor initially prescribed me my Nal.

3) Why I Drink More on Nal: Except for special occasions with friends, Nal has provided me with the psychological permission, for the first time since my university days, to drink as much as I feel like. No guilt, no shame. In fact, after taking my Nal, it is required that I drink in order to promote extinction. I currently drink more now (6 weeks in) than I did pre-Nal. There is likely more than one factor responsible for the increase, and I am not trying to say that it is due to a single factor, but man, not having to hide how much I drink in front of my wife, or futilely try to resist the next beer knowing deep down I will give always give in anyways, has lifted a great psychological burden off me.

4) Ninety-Nine Point Seven Percent Success: Women's oral contraceptive effectiveness is measured in 2 ways, by actual and perfect use. In perfect use, a women ingests the exact pill, according to her ovulation cycle, on a daily basis, and never misses a dose. The pregnancy rate of such use has been demonstrated to sit at around 0.3%. Women's contraceptive pharmaceuticals, however, have been widely studied and tested for over 70 years. Dosages are precise, and tailored to be effective and healthy. In comparison, actual use of the pill pegs the pregnancy rate at 2%-8% depending on the study. Many people are not properly explained instructions, or do not properly follow them. Now, imagine a drug that has very little public history, that has been demonstrated in a clinical setting to extinguish alcoholic craving in rats with a %100 success rate. The wave upon wave of clinical trials and pharmaceutic refinements necessary to replicate such a result in the human population are naturally years and hundreds of thousands of dollars away. Is 1 hour the most effective time frame? Could an SLR form be more effective? Is 50 mgs enough for all humans, or might certain chemistries require in excess of 100? How bad is it to miss a dose (I have), and how bad is it to take a pill and then decide to not drink? How do these affect average extinguishment times? What are the minimum and maximum extinguishment rates, so that those 8 or 9 months onwards on Nal might not lose hope? We are the pioneers, and unfortunately, although the potential rewards of the pioneers are great, the unknowing can be unbearable... Perhaps, like the contraceptive pill, once properly understood and administered Nal could deliver a 99.7% success rate.

Maybe I should have started a thread for each of these, I don't know, and much of the above has probably been discussed elsewhere. But, like most of you, I am fascinated by this drug, and am hopefully that I will be cured, and so wanted to share.

Cheers, looking forward to reading any responses,

Mark

Great post Mark. Three of your four very interesting topics have been discussed on this board either directly or indirectly. Your excellent final point has not been discussed at all, to my knowledge.

The consensus on this board is that side effects are definitely far more pronounced and significant than outlined in Eskapa's book. The vast majority of the people here report major side effects initially, but almost all of these dissipate rapidly, usually within a few weeks. These include nausea, fatigue, feeling very spacey, increased anxiety and sleep disturbance, among others. Many people -- but not all -- definitely report that during the initial stages when the body is getting used to the naltrexone, there is an immediate, short-term, sharp reduction in their interest in drinking (the "honeymoon period"). For me, I was nauseous and tired and had no interest in drinking after I first popped the naltrexone. My honeymoon period lasted about as long as the side-effects, or about three weeks. When the side effects diminished, my enthusiasm for drinking returned to pre-TSM levels. So I entirely agree with you that the "honeymoon effect" can be a side effect of naltrexone for many of us. I also entirely agree with you that this could be a starting point for naltrexone to be used as a craving reducer. However, this effect is very short-lived. Indeed, all of the more recent studies about naltrexone show that it is less effective than placebo in reducing long-term cravings.

Many of us here did drink more, or as much as we did pre-TSM, after the honeymoon period ended. (BTW, not everyone has the honeymoon period. A wild estimate on my part would be roughly fifty percent on this board.) I agree with you, many of us drink more initially under TSM because we now have license to do so under the method. However, we have identified another factor on this board that may be in play, namely "the extinction burst." If you search that term, you can find it discussed at length elsewhere on the board. In brief, it goes like this: when we drink on naltrexone the endorphin rush we are addicted to is blocked. As a result, we subconsciously drink more and more, in a vain effort to get the endorphin rush that is being blocked by naltrexone. This phenomenon has also been demonstrated under learning theory. If you teach a bird to peck a lever so it results in the bird getting a food pellet, when you stop giving the pellet, the bird initially pecks more vigorously in an attempt to get the food pellet it has become used to receiving. This would be like us, drinking more and more, trying to get the endorphin rush blocked by naltrexone. It doesn't last -- once we realize the endorphin rush is not coming, our drinking levels go down. I should note that the "extinction burst" theory, although subscribed to by many on this board (including me), is not addressed at all in Eskapa's book or the studies. The same applies to the honeymoon period, which is also not addressed in the book or the studies.

Your final point is especially interesting to me and I believe it is especially on point. The bottom line is that there are virtually no studies testing TSM. There are 102 studies summarized in the book about naltrexone but virtually all of them use the wrong protocol with instructions to take natlrexone as an anti-craving drug and with (the incorrect) instructions to abstain. The vast majority of the evidence supporting TSM came about by accident when subjects violated the instructions and drank on naltrexone when told to abstain. There are only a handful of naltrexone studies that examine extinction as a result of being told to drink on naltrexone. In addition, you have touched on several factors that have not yet been addressed by the studies and that could lead to a higher efficacy rate.

Here are two more issues that are glaringly absent from the book or the studies, namely: (1) the impact of the amount of drinking on the time it will take for extinction to occur and (2) the impact of the amount of time we have drank heavily on the amount of time it will take extinction to occur. The study relied on in the book that cites a three to four month cure period is for people who "only" consumed 35 drinks per week, on average. It also may have included college students (considering it was a university study) who were not long-term abusers of twenty or thirty or forty years, like many of us here on this board. However, we don't know because the age of the subjects and their drinking history is not addressed in the book or the studies. I believe that the principles of classical conditioning apply and that the longer you have been drinking and the more you have been drinking, then the longer it will take for extinction to occur. If so, this would explain why many of us on this board are seeing major results, but far after the three to four month period outlined in the book as the typical cure period. However, you will not find anything in the book or the studies addressing this critical issue: namely, how our drinking history (including duration and amounts) impacts the amount of time it will take for extinction to occur.

Great food for thought. Much of what you present is discussed inthis thread:
viewtopic.php?f=5&t=19
This is a FAQ Section that was left out of Eskapa's book. There's probably as much information packed into this section as is found in the entire book, in my view. I suggest we all go back and read it regularly.

I have another explanation for the fatigue most of us feel at first, based on what Eskapa has written. Alcohol is a depressant. Without Naltrexone, we don't get the endorphin-based energy boost that makes us the life of the party. So we are left to feel the depressant effectas of the alcohol. Most of us seem to adjust to that, but some of us don't.

I agree with the extinction burst and fatigue. The only side effect I felt to have been from the naltrexone that I experienced was some abdominal cramps. I have read people complain of bad dreams. I attribute this to the fact that before TSM I didn't dream or at least couldn't remember them. If I did I was probably too drunk for them to wake me.
Why don't Dr. Eskapa or Dr. Sinclair come out with more recent info on the method? Or push for clinical trials directly on TSM? There must be some info from Finland. I don't believe I have read anything published w/in 2 years.

Dr. Sinclair and the other researchers really have nothing to offer by doing more studies of their own. In order to gain acceptance, their research needs to be independently verified by other scientists. It has by a few small studies, and TSM has been implied to be effective by MANY MANY studies. There is info from Finland, the DBPC study that Dr. Sinclair and others did amounts to what is considered the "gold" standard in science.

I'm coming across more studies published within the last 2 years, but it's the same old BS (Naltrexone seems to be effective, but only after they drink). They measure the results after 12 weeks of treatment where people are trying to remain abstinent and get less than 12 weeks worth of extinction sessions. Then they declare the results significant and effective, but only among patients who drink... They follow up and find out that the people who drank while on Naltrexone, still...weeks after the treatment are drinking less than the people who tried to abstain.

These people will eventually drink as much as they always did and the next time they hear the word Naltrexone they'll say: Yeah I tried that...it didn't work.

I understand what you are saying. I just wish this could become more mainstream. I always thought it would be good to get one of the celebrities in the Betty Ford Clinic revolving doors to try it and endorse it.
Do you know where to look up specific results from Finland? Any gfovernment/ addictions endorsements? Showing long term sobriety/ controlled drinking?
I would like to see them. I will do my own searching also.

Very thoughtful replies, thanks everyone.

I agree with much of what was said above, thank you. (and BTW I will check out the FAQ next time before posting more theories! ).

We must accept that we are the seed, the pioneers, that our work will not be acknowledged until at the very least many months from now, and, much more likely a few years from now, our work is justified. The very best work we can do is to support each other, endure, and, most of all, demonstrate that most of us are cured through this method. The more successful we are, the faster this will grow in North America, of this I am convinced.

For those who are cured, spread the word.

For those who are still trying, like me, keep the faith.

Cheers, a drink to our health,

Z

I read something at one of the sites, not sure if I bookmarked it, that claimed the TSM has cure either 10k or 100k in Finland. You would think that with numbers like that that there would be numerous case studies, facts, etc. directly related to TSM. Maybe Dr. Eskapa can get some of the info.
Here is the link:
http://www.healthnewsdigest.com/news/Fa ... lism.shtml